This application is designed to reduce smoking prevalence and thus smoking related mortality and morbidity in the Native American population. It is proposed to assess the capability of a modified Doctors Helping Smokers model (incorporating culturally sensitive materials and Native American outreach workers) to produce a significant increase in smoking cessation over a "usual care" control in an American Indian population. The long-term maintenance of the key components of the Doctors Helping Smokers program will also be evaluated. Fourteen urban Indian health care clinics will be assigned randomly in matched pairs to an intervention or comparison condition. In each clinic, the first 75 smokers presenting themselves who meet the eligibility criteria and sign an informed consent form will be enrolled as study participants. The intervention consists of an integrated clinic-based system utilizing all staff members to supply prolonged reinforcement and support of maintenance to smokers interested in quitting. This will be supplemented by culturally-sensitive smoking cessation materials and the use of Native American outreach workers to deliver and reinforce the smoking cessation message. The comparison site will be limited to the availability of culturally-sensitive materials only. Evaluation will be almost identical in both the intervention and control sites. It will consist of a baseline interview and cardiovascular risk factor measurements, and a one-year follow-up interview and cardiovascular risk factor measurement. Cotinine tests will be carried out to validate self-reported abstinence at follow-up Clinics will be assessed to determine the extent to which they have successfully applied the Doctors Helping Smokers Model. Assessment will take place at the beginning and end of the study and will include analysis of patients; charts for labeling of Smoking status, reports of physicians and other staff concerning dispensing of smoking cessation advice, and exit interviews with random samples of patients to assess recollection of such advice.